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THE MINISTRY OF HEALTH

CIRCULAR No. 09/2000/TT-BYT OF APRIL 28, 2000 GUIDING HEALTHCARE FOR LABORERS AT MEDIUM AND SMALL-SIZE ENTERPRISES

Pursuant to the Law on Protection of the People�s Health of July 11, 1989;

Pursuant to Chapter IX of the Labor Code of June 23, 1994;

Pursuant to Decree No. 06/CP of January 20, 1995 of the Government detailing a number of articles of the Labor Code on labor safety and hygiene;

Pursuant to Decree 68/CP of October 11, 1993 of the Government providing for the functions, tasks, power and organizational structure must be informed of the of the Ministry of Health.

After consulting the Ministry of Labor, War Invalids and Social Affairs at Official Dispatch No.946/LDTBXH-BHLD of April 3, 2000;

The Ministry of Health provides the following guidance on healthcare for laborers at medium and small-size production, business and service enterprises:

I. OBJECT AND SCOPE OF APPLICATION

1. All the following organizations, individuals and units involved in production, business and service activities (collectively called enterprises):

State enterprises, enterprises of various economic sectors, companies, foreign- invested enterprises, limited liability companies, joint stock companies, cooperatives, production group of administrative, non-business agencies, social organizations and mass organizations, units of the armed forces and the people�s security forces.

2. Medical units assigned to care for the health of laborers.

II. DEFINITION OF MEDIUM AND SMALL-SIZE ENTERPRISES

Medium and small-size enterprises are provi-sionally defined under Official Dispatch No. 68/CP-KTN of June 20, 1998 of the Government as follows:

- A medium-size enterprise is an enterprise having from 51 to 200 laborers.

- A small-size enterprise is an enterprise having 50 laborers or less.

III. CONTENT OF HEALTHCARE FOR LABORERS AT MEDIUM AND SMALL-SIZE ENTERPRISES

1. Meeting all the norms on labor sanitation: The work place of laborers with noxious elements must have a clearly written internal rule placed at a vantage point. For work places having elements likely to cause occupational diseases laborers must be informed of the preventive measures so that they themselves can avoid diseases.

2. Organizing the popularization of methods of labor safety and sanitation: Annually, the labor manager must organize classes for laborers on the effect of the elements arising from the labor environment on health so that the latter may take measures to protect themselves against the harmful effect of the occupations and occupational diseases. The content of the training for laborers shall be prepared by the Prophylactic Medicine Teams at the Health Centers of the districts, provincial towns and cities, and the Prophylactic Medicine Centers of the provinces and centrally-run cities (hereafter collectively called provinces), the Labor Health Centers of the branches as stipulated in this Circular (Appendix 1).

3. First-aid organization: The employers must organize well first- aid work at the enterprises. First-aid workers must be trained professionally and provided with certificates issued by the Prophylactic Medicine Center of the province or centrally-run city, the Labor Health Centers of the Ministry or branch, the Health Center of the district or town (hereafter collectively called district). Each workshop must have a first-aid kit as listed in this Circular (Appendix 2). First-aid regulations shall be presented and directed at the work place so that the laborers can know the enforcement thereof.

4. Drawing up the labor hygiene dossier: Each enterprise must compile a labor dossier according to the form stipulated at Circular No. 13/TT-BYT of October 21,1996. The results of laboratory tests, labor environment inspection and periodical health-check shall be supplemented annually in the labor hygiene dossier.

5. Laboratory test and inspection of labor environ-ment: Annually, enterprises must organize laboratory tests and inspection of the labor environment, evaluate the harmful effect of the labor environment in order to take measures to improve the labor conditions and environment. The results of the tests and inpection of the labor environment shall be handled as stipulated in Circular No.13/BYT-TT of October 21, 1996, and according to the following assignment:

- By the provincial Prophylactic Medicine Center, for the enterprises with high risk of occupational diseases;

- By the Prophylactic Medicine Team of the district Health Center for other enterprises.

The Prophylactic Medicine Team shall inventory and draw up the list of different types of enterprises and propose the provincial Prophylactic Medicine Center to coordinate in the realization.

6. Conducting recruitment health-check: Before admission to work, the laborers (including job learners) must have a health check; the employer must base himself/herself on the laborer�s health to assign an appropriate job or occupation. A copy of the recruitment health-check dossier must be kept in the health dossier.

7. Periodical health-checks: The employer has the responsibility to organize periodical health-checks for the laborers at least once a year. The aim of this health-check is:

a/ To detect pathological symptoms and indications related to the job in order to detect occupational diseases at their early stage, give prompt treatment, and organize prevention against occupational diseases.

b/ To monitor those with chronic diseases or poor health in order to adopt plans to send them to sanatoria and functional rehabilitation centers.

The organization of health-checks must be uncumbersome, not necessarily involving all the specialties, but there must be the necessary specialties that can diagnose occupational diseases. The periodical health check dossier shall be made according to the set.

Classification health-check is an overall health-check in all specialties to evaluate and classify the health condition of all laborers in the enterprise. This check must be organized at least once every three years. Where conditions permit, periodical checks may be combined with annual health classification.

8. Health-checks for early detection of occupational diseases: For laborers working in noxious environments liable to occupational diseases, the employer shall have to organize health-checks for early detection of occupational diseases. This type of health-check should be combined with periodical health-check at the establishments liable to occupational diseases. The examination to detect occupational diseases shall be conducted by the occupational disease examination room which shall complete the dossier as currently prescribed.

9. Evaluation of health due to labor accidents and occupational diseases: All laborers being victims of labor accidents or suffering from occupational diseases shall enjoy occupational health-checks at the Medical Evaluation Board. The sufferers of occupational diseases must be re-examined every six months, receive treatment and functional rehabilitation at medical establishments. Provisions on occupational diseases shall be applied according to Joint Circular No.08/1998/TTLT/BYT-BLDTBXH of April 20, 1998 of the Ministry of Health and the Ministry of Labor, War Invalids and Social Affairs.

10. Allowances in kind: If after the labor environmental conditions have been improved, the noxious elements still do not meet the allowed hygiene criteria, the employer shall have to provide allowances in kind to the laborers working in this environment (pursuant to Joint Circular No. 10/1999/TTLT/BLDTBXH-BYT of March 17, 1999). The medical staff at all level shall provide consultancy for the owners of enterprises on the kind of allowances (sugar, milk, fruit...) to be provided according to the characteristics of the jobs.

11. Facilities in service of laborers: The work place of the laborers must have all the sanitary facilities, including: toilet, sufficient clean water, bathroom, rest room and clean and hygienic dining room. Each enterprise shall build a "health corner" where the laborers can read books, leaflets, posters on disease prevention and use of the first-aid kit. This may be a separate room if the enterprise can afford it.

IV. RESPONSIBILITY OF MANAGING AND CARING FOR THE HEALTH OF LABORERS AT MEDIUM AND SMALL ENTERPRISES

A. RESPONSIBILITIES OF THE ENTERPRISE OWNERS

1. As stipulated in Joint Circular No. 14/1998/TTLT-BLDTBXH-BYT-TLDLDVN of October 13, 1998 of the Ministry of Labor, War Invalids and Social Affairs, the Ministry of Health and the Vietnam Confederation of Labor, the assignment of medical workers to care for the health of laborers at medium and small enterprises shall proceed as follows:

- If the enterprise already has a doctor, a physician or a medical station, it shall leave them as such for the healthcare service.

- If the medium enterprise does not yet have a medical staff, it must assign a medical worker to this job.

- For a small enterprise not qualified to use a medical worker to care for the health of laborers, it may sign a contract with medical staff at the medical station or retired medical workers to work on given days and hours, but it must register with the Medical Center of the district to receive the latter�s common guidance. The medical worker can concurrently assume other jobs to conform with the labor management of the enterprise.

- To organize a safety and sanitation net at the enterprise for on- the- spot first- aid when an accident occurs.

2. The medical workers caring for the health of laborers at the enterprise must be trained in the program of labor safety and hygiene directed by the Prophylactic Medicine Team of the District Health Center, the Prophylactic Preventive Medicine Center, the Labor Medicine Center of the branch or training establishments.

3. The medical workers working in medium and small-size enterprises shall submit to the direct specialized guidance of the medical station of the ward, commune, township and of the District Health Center (the Prophylactic Medicine Team) in terms of labor healthcare.

4. The enterprise must carry out well primary healthcare, conduct timely first aid and carry out examination and treatment of common diseases for the laborers, popularize disease prevention methods and educate the laborers thereon.

B. RESPONSIBILITIES OF THE COMMUNE, WARD AND TOWNSHIP HEALTH SERVICES

The Health Service at the commune, ward or township has the responsibility to direct and coordinate with the medium and small enterprises located in the locality in carrying out the following tasks:

1. To intensify the popularization and education work, regularly inspect and promote labor safety and hygiene work; take the initiative in actively preventing diseases, and when an epidemic breaks out to take part in and organize its prompt stamping out.

2. To have a firm account of the enterprises and noxious elements in order to take measures to guide the healthcare for the laborers.

3. To manage the health dossiers of laborers at the medium and small-size enterprises in the locality.

4. To organize first aid to the patients, victims of labor accidents, chemical poisonings and other incidents.

5. To popularize methods of preventive hygiene against epidemics and occupational diseases for the laborers.

C. RESPONSIBILITIES OF THE MEDICAL CENTERS (PROPHYLACTIC MEDICINE TEAMS) IN THE DISTRICTS AND TOWNSHIP UNDER THE PROVINCE

By Decision No.2468 /1999/ QD -BYT of August 17, 1999 of the Minister of Health the responsibilities of the Prophylactic Medicine Team are specified as follows:

1. To popularize to the enterprises located in the locality and urge the implementation of the measures of treatment of excreta, waste water, garbage and other waste materials in the process of production... according to the technical guidance of the higher echelon.

2. To guide the enterprises in drawing up the dossiers of labor hygiene, control the noxious elements in the labor environment, manage the health of laborers. These labor hygiene dossiers shall be made in two copies, one to be kept at the enterprise and the other at the Prophylactic Medicine Team.

3. To inspect and urge the enterprises to carry out measures to control and eliminate the noxious elements arising in the production process in order to assure the requirements in labor hygiene and safety. To guide, inspect and urge the implementation of the regulations on labor hygiene and safety as currently prescribed by law in order to prevent and fight against occupational diseases for the laborers.

4. To organize periodical health-checks for the laborers: the Prophylactic Medicine Team shall draw up plans with the enterprises about the time and number of examinees and the specialties that will carry out the checks. The periodical health-check team must be light and uncumbersome, but must assure these requirements: diagnosis, prescription of method of treatment and organization of prevention of diseases related to the noxious elements in the labor environment and liable to cause occupational diseases. The periodical heath-check team must make recommendation so that the labor employers may settle the regime of treatment, convalescence and rehabilitation for persons with pathological signs and feasible measures to improve the labor environment according to the labor hygiene and safety norms.

5. To coordinate with the local specialized agencies in organizing the inspection of the implementation of State regimes and policies to protect the health of laborers.

6. To organize the popularization and education on heath safety for laborers working in the locality under its management, paying attention to prevent and combat against poisoning by plant protection drugs and noxious elements arising in the production process.

7. To integrate the plan of labor medicine of the wards, communes and district townships and report to the Provincial Health Service, and the provincial preventive medicine center.

D. RESPONSIBILITIES OF THE PROPHYLACTIC MEDICINE CENTERS OF THE PROVINCES AND CENTRALLY-RUN CITIES

1. To direct the formulation of yearly plans of healthcare for laborers in medium and small-size enterprises.

2. To organize professional training for lower echelons in labor safety and health.

3. To guide in the test and inspection of labor environment and complete the dossiers as prescribed.

4. To manage and guide the periodical health-checks and examinations for early detection of occupational diseases of laborers at the establishments facing the risk of occupational diseases.

5. To guide the popularization, education and training on health security for the district echelon and the medical establishments. Attention must be paid to the prevention and fight against poisoning by plant protection drugs.

6. To inspect and promote the observance of the regimes of reporting of the echelons and integrate them into a report to the higher echelon.

7. To make an overall review each year in order to draw experiences in the organization of healthcare for laborers working at medium and small-size enterprises.

E. RESPONSIBILITIES OF THE LABOR HEALTH CENTERS OF THE MINISTRIES AND BRANCHES

1. To closely coordinate with the medical service in the localities to carry out together the common jobs of the branch in the domain of labor safety and hygiene and prevention and fight against occupational diseases.

2. To guide the drawing up of plans to ensure labor safety and hygiene and to prevent and fight against occupational diseases yearly at medium and small-size enterprises.

3. To guide the implementation of the services of laboratory test and inspecting the labor environment, periodical health checks, and health check for early detection of occupational diseases.

4. To organize the convalescence and care for the rehabilitation and treatment of the victims of labor accidents and patients of occupational diseases.

5. To popularize to the laborers and train and educate them on labor safety and hygiene and in the prevention and fight against occupational diseases.

6. To inspect, review and draw experiences in healthcare for laborers.

F. RESPONSIBILITIES OF THE HEALTH SERVICES IN THE PROVINCES AND CENTRALLY-RUN CITIES

1. To organize, manage and conduct overall guidance in healthcare for laborers at the medium and small-size enterprises in the locality.

2. To popularize and guide the implementation of State documents on labor safety and hygiene for the medical establishments and enterprises.

3. To build and consolidate the medical network of the enterprises, the medical service at various levels in conducting labor hygiene, and in the prevention and fight against occupational diseases.

4. To strengthen and upgrade the technical equipment in service of the laborers.

5. To assign the medical staff and create conditions for raising their standard in order to fulfill well the task of healthcare for laborers.

6. To inspect the implementation of the State regimes on health care for laborers at the enterprises.

V. REPORTING REGIME

The reporting regime shall comply with Circular No.13/BYT-TT of October 21, 1996 and is stipulated as follows:

Quarterly reports: Every three months, the enterprises shall complete their reports to the Medical Center of the district, town or city under the province (the Prophylactic Medicine Team) and the commune/ward health station on the 20th of March, June, September and December. If the enterprise belongs to a ministry or branch, it shall have to send one more copy of the report to the Labor Health Center of the branch.

Half-year and yearly reports:

- The Health Center of the district, town or city under the province shall report to the Health Service and Preventive Medicine Center of the province on the 20th of June and December.

- The Health Service of the province (Preventive Medicine Center of the province), the Labor Health Center of the Ministry or branch shall report to the Ministry of Health (Preventive Medicine Department) as prescribed.

VI. ORGANIZATION OF IMPLEMENTATION

1. The Health Services of the provinces and centrally-run cities shall have to elaborate the plans of organizing the implementation of this Circular, submit them to the People�s Committees of the centrally-run provinces and cities for approval in order to popularize them and direct the various echelons to implement them at the medium and small-size enterprises located in the localities.

2. The Ministries, branches and agencies which employer shall direct and urge the establishments under their management to comply with the regulations on healthcare for laborers at medium and small-size enterprises.

3. The labor employers at medium and small-size enterprises have the responsibility to provide fully the healthcare for laborers stipulated in this Circular.

This Circular takes effect 15 days after its signing for issuance. In the process of its implementation, if any difficulties arise the units and localities should report to them the Ministry of Health (the Prophylactic Medicine Department) for study and timely settlement.

For the Minister of Health

Vice Minister
NGUYEN VAN THUONG

Appendix 1

LIST OF CONTENTS OF TRAINING IN LABOR HYGIENE AND FIRST AID TO LABORERS

(issued together with Circular No.09/2000/TT-BYT of April 28,2000)

Contents Number of

study hours

I. Labor hygiene, prevention and fight against occupational diseases 12

1. Harmful effect of temperature and micro climate at work place and

measures of prevention.

2. Harmful effect of heat radiation and measures of prevention.

3. Harmful effect of dust of various types and measures of prevention.

4. Harmful effect of noise, vibration and measures of prevention.

5 Harmful effect of chemicals and measures of prevention.

6. Brief on occupational diseases covered by social insurance.

II. On- the- spot first aid in case of: 12

1. Electrocution.

2. Burns.

3. Asphyxiation.

4. Heart stoppage.

5. Blood stanching.

6. Transportation of patients.

7. First aid to victims of chemicals.

Appendix 2

REGULATIONS ON FIRST AID KIT

(issued together with Circular No.09/2000/TT-BYT of April 28,2000)

1. Place to put firt aid kit:

- Kits shall be put at work places of laborers.

- Kits shall be put at places most visible, easy to find, with a specific sign (usually a red cross).

- Notifying the laborers of the place of the kit and use method.

2. Equipment, tools and medicine for the first aid kit

- The first aid kit must have enough equipment and instruments for use in emergency, not to put other things in the kit.

- To check the first aid kit regularly to ensure sufficient instruments.

Kit A Kit B Kit C

Number Minimum equipment (for 25 (for 50 (for 100

workers) workers) workers)

1 Adhesive tape (roll) 02 02 04

2 Bandage 5 x 200cm (roll) 02 04 06

3 Medium bandage 10 x 200 cm (roll) 02 04 06

4 Large bandage 15 x 200 cm (roll) 01 02 04

5 Absorbent pad (10 pieces/box) 01 02 04

6 Absorbent wool (box) 05 07 10

7 Triangular bandage (unit) 04 04 06

8 Rubber garrot 6 x 100 cm (unit) 02 02 04

9 Rubber garrot 4 x 100 cm (unit) 02 02 04

10 Scissors (pair) 01 01 01

11 Clamp 04 04 06

12 Disposable glove (pair) 02 02 04

13 Suitable gas mask 01 01 02

14 Sterilized water or salt solution in 100 ml

disposable bottles (where running water

is not available) 01 03 06

15 Arm fixture (set) 01 01 01

16 Forearm fixture (set) 01 01 01

17 Thigh fixture (set) 01 01 02

18 Shin fixture (set) 01 01 02

19 Disinfectant (bottle) 01 01 02

20 First-aid plan 01 01 01

3. Quantity of first aid medicine kits

The quantity of necessary first aid boxes or kits depends on the disposition at the establishment and the number of laborers. There should be at least 1 first aid box or kit at each floor of the building. The total of kits of different types is indicated below, depending on the number of laborers.

Number of laborers Quantity and type of first-aid bags

Under 25 persons At least 01 kit type A

From 26 to 50 persons At least 01 kit type B

From 51 to 150 persons At least 01 kit type C

Note: 01 kit type B is equivalent to 02 kits type A, and 01 kit type C is equivalent to 02 kits type B.